Sterling Health HMO
Sterling Health HMO is a National Health Insurance Agency (NHIA)-accredited Health Maintenance Organization (HMO) that has been delivering high-quality, affordable healthcare services nationwide since 2007. We are committed to providing 24/7 healthcare support to both the public and private sectors.
Location: Lagos
Employment Type: Full-time
Position Overview
We are looking for a dedicated and detail-oriented Call Centre Agent to join our team. In this role, you will play a key part in processing healthcare claims efficiently and accurately while ensuring compliance with insurance policies and industry regulations.
Job Responsibilities
- Review and assess submitted healthcare claims for accuracy, completeness, and eligibility based on Sterling Health Insurance policies and guidelines.
- Verify patient eligibility and coverage details to ensure claims meet the necessary requirements.
- Apply medical coding knowledge (e.g., ICD-10, CPT) to evaluate the appropriateness of services rendered.
- Identify and investigate discrepancies, errors, or potential fraudulent claims.
- Communicate with healthcare providers and enrollees to obtain necessary information or clarification regarding claims.
- Process claims accurately and within the established turnaround times.
- Utilize the claims processing system effectively to input, review, and finalize claims.
- Maintain accurate and up-to-date records of all claims processed and actions taken.
- Adhere to all relevant regulatory requirements and internal policies related to claims processing.
- Stay updated on changes in medical coding, billing guidelines, and insurance regulations.
- Collaborate with other members of the Claims Department and other internal teams to resolve complex claims issues.
- Prepare reports on claims processing activities and trends as required.
- Assist in the development and implementation of claims processing procedures.
- Perform other claims-related duties as assigned.
How to Apply
Interested and qualified candidates are encouraged to forward their CV with the job title as the subject of the email.
Application Deadline
Not Specified.
To apply for this job email your details to Sterlinghmo@gmail.com